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Abstract

In periodontitis, there is a disruption in the homeostasis of the oral microbiome by peridontopathogenic bacteria. However, while bacteria is essential for periodontitis to occur, the severity, pattern and progression of the disease is not solely determined by the microbial burden, and in fact has a lot to do with the overwhelming host inflammatory response. The response can vary even in two individuals with similar periodontopathogenic profiles. The host response leads to extracellular matrix (ECM) destruction, loss of attachment, alveolar bone resorption and eventually, edentulism. The host's reaction is orchestrated by proinflammatory cytokines and chemokines and matrix metalloproteinases (MMPs). MMPs are proteolytic enzymes capable of degrading collagen fibers from the extracellular matrix and are the main responsible for tissue damage and gingival recession in periodontitis. As a response to the limitations of the traditional therapies, new agents have been used in preclinical and clinical studies, namely host-modulatory agents, including anti-proteinase agents, anti-inflammatory agents and anti-resorptive agents. Focusing on changing the inflammatory process, as opposed to the microbial insult, can slow down the disease progression, improve clinical outcomes and even prevent tooth loss in severely compromised patients. This work examines the role of pro-inflammatory markers homocysteine in chronic inflammation and periodontitis. Homocysteine (Hcy) is a non-protein amino acid derived from the metabolism of the essential amino acid methionine via methyl group metabolism. Controlling Homocysteine as a potential inductor of MMPs, and hence of tissue destruction, can lead to new adjuvant therapies to improve clinical outcomes and prevent activation of the disease